Basic Information
| Provider Information | |||||||||
| NPI: | 1023555299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELEYO | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 VALLEY BROOK RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | MC MURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153173367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249415588 | ||||||||
| FaxNumber: | 7249411458 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 VALLEY BROOK RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | MC MURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153173367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249415588 | ||||||||
| FaxNumber: | 7249411458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2017 | ||||||||
| LastUpdateDate: | 11/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP016908 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 103256442 | 05 | PA | MEDICAID |